How Adequately is the Severity of Atopic Dermatitis Assessed by Resident Physicians Training in Dermatology? Evaluation of the Intrarater and Interrater Reliability of Clinical Scoring Systems (EASI, oSCORAD, IGA, TIS Score, SASSAD)

Various scoring systems for atopic dermatitis assess different aspects of the disease, but the supporting data on their validation and reliability are often limited. To ensure accurate interpretations, it is essential to conduct thorough reliability and agreement testing. This study aimed to evaluate the reliability and reproducibility of 5 atopic dermatitis assessment tools - Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis Index (oSCORAD), validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD), Three Item Severity (TIS) score, and Six-Area, Six-Sign Atopic Dermatitis (SASSAD) severity score - among trained dermatology residents. Thirteen patients were assessed twice by 11 raters using each scoring system. Intrarater and interrater reliability were evaluated. EASI demonstrated the highest interrater reliability (ICC = 0.768 and 0.796); SASSAD and oSCORAD followed closely (ICC = 0.741 and 0.772; ICC = 0.723 and 0.709, respectively). The TIS (ICC=0.553 and 0.584) and IGA (Kendall's W=0.273 and 0.315) exhibited the lowest reliability. Given the generally higher reliability in this study compared with previous research, implementing standardized training on atopic dermatitis scoring systems early in the education of resident physicians may improve the reliability of these tools, equipping future dermatologists to perform effectively in clinical trials and drug programmes.